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Menopause, hormones and your heart

November 16, 2015Menopause and You

The relationship between hormone replacement therapy—now called menopause hormone therapy—and heart health has always been a complicated one. While it was once thought to help reduce the risk of heart disease, it has also been advised against because of how it could potentially affect a woman’s heart disease risk. So, once and for all, what is menopause hormone therapy’s effect on your heart?

“Menopause hormone therapy is generally a safe option for women, and won’t have a negative effect on their heart health, if it is started in the early menopausal period,” says Beverly Vaughn, MD, gynecologist with Main Line HealthCare Gynecology at Lankenau Medical Center. “Of course, as with every medicine or procedure, women should be evaluated on a case-by-case basis to determine if menopause hormone therapy is right for them but, for most women, it can be considered a safe option.”

There are two types of menopause hormone therapy: estrogen therapy and estrogen/progesterone/progestin therapy. Thus far, studies suggest that estrogen-only methods of menopause hormone therapy tend to be the most effective in decreasing menopause symptoms without affecting heart health. Estrogen-only therapy is reserved for women who have had a hysterectomy and do not have a uterus. Combined hormone therapy methods—those that contain estrogen, progesterone, and progestin (synthetic progesterone)—may present a minimal increase in heart disease risk. Women who have do have a uterus need combined therapy, as estrogen-only therapy increases their risk for endometrial (uterine) cancer.

Is menopause hormone therapy right for me?

Although most women can be considered candidates for menopause hormone therapy, young, healthy women who enter early menopause are considered to be at the lowest risk for any cardiac complications as a result of the treatment.

Certain groups may not be eligible to receive menopause hormone therapy, including women who have a prior history of breast cancer, blood clots, prior heart attack or stroke or who are at increased risk for heart disease because of existing medical conditions.

“If a woman’s personal risk factors or family history put her at an increased risk for heart disease, then menopause hormone therapy may not be an option for her but, fortunately, there are other options available to control hot flashes, and vaginal menopause symptoms can be treated with topical estrogen without increasing heart disease risk,” says Dr. Vaughn. “Women who have pre-existing risk factors should talk to their physician about other options.”

While menopause hormone therapy is generally safe to use to prevent the symptoms of menopause, it isn’t an appropriate treatment for reducing heart disease risk, says Dr. Vaughn.

“Many years ago, there was thought that menopause hormone therapy could actually be prescribed to help reduce heart disease risk but, today, it’s used almost exclusively for the treatment of menopausal symptoms,” she explains.

Reducing your heart disease risk

Whether or not you decide to pursue menopause hormone therapy, it’s important to control your heart disease risk during menopause, as it’s a time when most women’s heart disease risk increases.

“We know that most women’s heart health risks increase after menopause, which is why it’s important to make a long-term commitment to controlling risk factors even before menopause,” says Dr. Vaughn.

A diet of fresh fruits and vegetables, healthy fats like nuts, lean meats, and fish, and moderate portions of carbohydrates and dairy can help maintain both a healthy weight and a healthy heart. Exercise also plays a vital role in healthy living.

After menopause cholesterol, triglycerides and blood pressure may increase, all of which can contribute to heart disease. During visits with your primary care doctor, be sure to review these values.

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